A nationwide study of the incidence rate of herb-induced liver injury in Korea

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Abstract

Discrepant incidence has been reported regarding the incidence of herb-induced liver injury (HILI). To address the growing worldwide concern of HILI, we evaluated the risk of HILI in a nationwide prospective study. Between April 2013 and January 2016, 1001 inpatients (360 males and 641 females) from 10 tertiary hospitals throughout South Korea were treated with herbal drugs and had their liver enzymes periodically measured. A total of six patients met the criteria for HILI with RUCAM scores ranging from 4 to 7. All these participants were women and developed the hepatocellular type of HILI. One HILI participant met the criteria for Hy’s law; however, none of six cases presented clinical symptoms related to liver injury. This is the first nationwide prospective study that estimated the extent of the incidence of HILI [total: 0.60%, 95% confidence interval (CI) 0.12–1.08; women: 0.95%, 95% CI 0.19–1.68] and described its features in hospitalized participants.

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Most cited references 20

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Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States.

Naga Chalasani, Robert J. Fontana, Herbert L. Bonkovsky … (2008)

Idiosyncratic drug-induced liver injury (DILI) is among the most common causes of acute liver failure in the United States, accounting for approximately 13% of cases. A prospective study was begun in 2003 to recruit patients with suspected DILI and create a repository of biological samples for analysis. This report summarizes the causes, clinical features, and outcomes from the first 300 patients enrolled. Patients with suspected DILI were enrolled based on predefined criteria and followed up for at least 6 months. Patients with acetaminophen liver injury were excluded. DILI was caused by a single prescription medication in 73% of the cases, by dietary supplements in 9%, and by multiple agents in 18%. More than 100 different agents were associated with DILI; antimicrobials (45.5%) and central nervous system agents (15%) were the most common. Causality was considered to be definite in 32%, highly likely in 41%, probable in 14%, possible in 10%, and unlikely in 3%. Acute hepatitis C virus (HCV) infection was the final diagnosis in 4 of 9 unlikely cases. Six months after enrollment, 14% of patients had persistent laboratory abnormalities and 8% had died; the cause of death was liver related in 44%. DILI is caused by a wide array of medications, herbal supplements, and dietary supplements. Antibiotics are the single largest class of agents that cause DILI. Acute HCV infection should be excluded in patients with suspected DILI by HCV RNA testing. The overall 6-month mortality was 8%, but the majority of deaths were not liver related.

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Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period.

Ramon Planas, Joan Costa, Aina Soler … (2005)

Progress in the understanding of susceptibility factors to drug-induced liver injury (DILI) and outcome predictability are hampered by the lack of systematic programs to detect bona fide cases. A cooperative network was created in 1994 in Spain to identify all suspicions of DILI following a prospective structured report form. The liver damage was characterized according to hepatocellular, cholestatic, and mixed laboratory criteria and to histologic criteria when available. Further evaluation of causality assessment was centrally performed. Since April 1994 to August 2004, 461 out of 570 submitted cases, involving 505 drugs, were deemed to be related to DILI. The antiinfective group of drugs was the more frequently incriminated, amoxicillin-clavulanate accounting for the 12.8% of the whole series. The hepatocellular pattern of damage was the most common (58%), was inversely correlated with age (P < .0001), and had the worst outcome (Cox regression, P < .034). Indeed, the incidence of liver transplantation and death in this group was 11.7% if patients had jaundice at presentation, whereas the corresponding figure was 3.8% in nonjaundiced patients (P < .04). Factors associated with the development of fulminant hepatic failure were female sex (OR = 25; 95% CI: 4.1-151; P < .0001), hepatocellular damage (OR = 7.9; 95% CI: 1.6-37; P < .009), and higher baseline plasma bilirubin value (OR = 1.15; 95% CI: 1.09-1.22; P < .0001). Patients with drug-induced hepatocellular jaundice have 11.7% chance of progressing to death or transplantation. Amoxicillin-clavulanate stands out as the most common drug related to DILI.

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A prospective nationwide study of drug-induced liver injury in Korea.

Ki Suk, Dong Joon Kim, Chang-Hoon Kim … (2012)

To address a growing concern about drug-induced liver injury (DILI), a nationwide study was performed to investigate the significance of DILI in Korea.

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Author and article information

Contributors

Chang-Gue Son:

ORCID: http://orcid.org/0000-0003-4876-0167

+82-42-229-6807 , ckson@dju.ac.kr

Journal

Journal ID (nlm-ta): Arch Toxicol

Journal ID (iso-abbrev): Arch. Toxicol

Title: Archives of Toxicology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0340-5761

ISSN (Electronic): 1432-0738

Publication date (Electronic): 20 June 2017

Publication date PMC-release: 20 June 2017

Publication date (Print): 2017

Volume: 91

Issue: 12

Pages: 4009-4015

Affiliations

[1 ]GRID grid.459450.9, Hepatology Department, , Daejeon Oriental Hospital of Daejeon University, ; 176-9 Daeheung-ro, Jung-gu, Daejeon, 34929 South Korea

[2 ]ISNI 0000 0000 8749 5149, GRID grid.418980.c, The K-herb Research Centre, Korea Institute of Oriental Medicine, ; Daejeon, South Korea

[3 ]ISNI 0000 0001 0310 3978, GRID grid.412050.2, Department of Internal Medicine, , Dongeui Oriental Hospital of Dongeui University, ; Busan, South Korea

[4 ]ISNI 0000 0004 0533 259X, GRID grid.443977.a, Department of Internal Medicine, , Oriental Hospital of Semyung University, ; Jecheon, South Korea

[5 ]ISNI 0000 0001 0523 5122, GRID grid.411948.1, Department of Internal Medicine, , Cheonan Oriental Hospital of Daejeon University, ; Cheonan, South Korea

[6 ]Department of Internal Medicine, Ulsan Oriental Hospital of Dongeui University, Ulsan, South Korea

[7 ]ISNI 0000 0001 0719 8572, GRID grid.262229.f, School of Korean Medicine, , Pusan National University, ; Busan, South Korea

[8 ]ISNI 0000 0004 1790 9085, GRID grid.411942.b, Department of Internal Medicine, , Oriental Hospital of Daegu Haany University, ; Daegu, South Korea

[9 ]ISNI 0000 0001 2171 7818, GRID grid.289247.2, Department of Internal Medicine, , Kyung Hee University Oriental Medical Hospital, ; Seoul, South Korea

[10 ]ISNI 0000 0004 0533 4755, GRID grid.410899.d, Department of Internal Medicine, , Oriental Hospital of Wonkwang University, ; Iksan, South Korea

[11 ]ISNI 0000 0004 1770 4266, GRID grid.412069.8, Department of Internal Medicine, , Oriental Hospital of Dongshin University, ; Suncheon, South Korea

[12 ]ISNI 0000 0004 0647 2025, GRID grid.470171.4, Department of Internal Medicine, , Daejeon St. Mary’s Hospital of Catholic University, ; Daejeon, South Korea

[13 ]ISNI 0000 0001 0523 5122, GRID grid.411948.1, Department of Health Service Management, , Daejeon University, ; Daejeon, South Korea

Author information

Chang-Gue Son http://orcid.org/0000-0003-4876-0167

Article

Publisher ID: 2007

DOI: 10.1007/s00204-017-2007-9

PMC ID: 5719126

PubMed ID: 28634823

SO-VID: 38d4a7de-1e49-4ad4-bb19-b4223a15916d

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 11 May 2017

Date accepted : 1 June 2017

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ScienceOpen disciplines: Toxicology

Keywords: drug-induced liver injury,liver,alternative medicine,epidemiology,herb-induced liver injury,adverse drug reaction,incidence

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ScienceOpen disciplines: Toxicology

Keywords: drug-induced liver injury, liver, alternative medicine, epidemiology, herb-induced liver injury, adverse drug reaction, incidence

A nationwide study of the incidence rate of herb-induced liver injury in Korea

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Journal of the Netherlands Society of Toxicology

Most cited references 20

Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States.

Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period.

A prospective nationwide study of drug-induced liver injury in Korea.

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